Practical Nurse GS-0620-03/04/05

Enter your Social Security Number in the space indicated. Your Social Security Number is requested under the authority of Executive Order 9397 to uniquely identify your records from those of other applicants who may have the same name. As allowed by law or Presidential directive, your Social Security Number is used to seek information about you from employers, schools, banks and others who may know you. Providing your Social Security Number is voluntary, however we can not process your application without it.

Vacancy Identification Number

The Vacancy Identification Number is 8574971. Title of Job

Practical Nurse GS-0620-03/04/052. Biographic Data

3. E-Mail Address

4. Work Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

5. Employment Availability

6. Citizenship

Are you a citizen of the United States?7. Background Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

8. Other Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

9. Languages

If you are applying by the OPM Form 1203-FX, leave this section blank.

10. Lowest Grade

Enter the lowest grade level that you will accept for this position. The lowest grade for this position is 03.

030405

11. Miscellaneous Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

12. Special Knowledge

If you are applying by the OPM Form 1203-FX, leave this section blank.

13. Test Location

If you are applying by the OPM Form 1203-FX, leave this section blank.

14. Veteran Preference Claim

15. Dates of Active Duty - Military Service

16. Availability Date

17. Service Computation Date

If you are applying by the OPM Form 1203-FX, leave this section blank.

18. Other Date Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

19. Job Preference

If you are applying by the OPM Form 1203-FX, leave this section blank.

20. Occupational Specialties

Select/enter at least one occupational specialty. The specialty code for this position is:

001 Practical Nurse - SER -DH

21. Geographic Availability

Select/enter at least one geographic location in which you are interested and will accept employment. The location code for this position is:

If you are applying by the OPM Form 1203-FX, leave this section blank.

24. Personal Background Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

25. Occupational/Assessment Questions:

1. Are you a United States Citizen or National, who is at least 16 years old?

A. YesB. No

Section 231 of the Crime Control Act of 1990, Public Law 101-647, requires that employment applications for individuals seeking employment in a position involved with the provision to children under the age of 18 of “child care services,” as defined in 42 U.S.C. 13041(a)(2), contain a question asking whether the individual has ever been arrested for or charged with a crime involving a child and for the disposition of the arrest or charge. Under 42 U.S.C. 13041(a)(2), the term "child care services" means child protective services (including the investigation of child abuse and neglect reports), social services, health and mental health care, child (day) care, education (whether or not directly involved in teaching), foster care, residential care, recreational or rehabilitative programs, and detention, correctional, or treatment services. Individuals hired for such positions must undergo a criminal history background check. Section 408 of the Indian Child Protection and Family Violence Prevention Act, Public Law 101-630, contains a related requirement for positions in the Department of Health and Human Services that involve regular contact with or control over Indian children. The agency must ensure that persons hired for these positions have not been found guilty of or pleaded nolo contendere or guilty to certain crimes. The law requires that the agency conduct an investigation of the character of each individual who is being considered for employment in such a position and prescribe in regulations the “minimum standards of character” that must be met in order for an individual to fill such a position. The regulations specify that “[t]he minimum standards of character shall be considered met only after the individual has been the subject of a satisfactory background investigation,” which includes a criminal history background check. 42 C.F.R. § 136.406.

2. Have you ever been arrested for or charged with a crime involving a child?

A. YesB. No

3. Have you ever been found guilty of, or entered a plea of nolo contendere (no contest) or guilty to, any felonious or misdemeanor offense under Federal, State or tribal law involving crimes of violence; sexual assault, molestation, exploitation, contact or prostitution; or crimes against persons; or offenses committed against children?

A. YesB. No

If “YES”, provide the date, explanation of the violation, disposition of the arrest or charge, place of occurrence, and the name and address of the police department or court involved.

The following section is used to determine your eligibility for appointment under the Delegated Examining or Direct Hire Authority in the Indian Health Service. Please respond "Yes" or "No" to the following statements. Do not leave any section blank.

The following section is used to determine your eligibility for appointment under the Delegated Examining or Direct Hire Authority in the Indian Health Service. Please respond "Yes" or "No" to the following statements. Do not leave any section blank. NOTE: You must submit the required documentation to verify eligibility as indicated below. Failure to provide documents will render you not eligible for the consideration. See instructions undert the "How to Apply" tab for submitting documentation.

A- Yes.B- No.

4. Are you eligible for Indian preference as defined by the Department of the Interior (DOI) and as evidenced by appropriate Bureau of Indian Affairs (BIA) authorized certification? (You must submit a properly completed and signed copy of the Bureau of Indian Affairs (BIA) Form BIA-4432, "Verification of Indian Preference for Employment in the Bureau of Indian Affairs and the Indian Health Service," for employees claiming Indian preference.)

5. Are you an Indian Health Service scholarship recipient who has completed the necessary requirements for an approved health profession degree in accordance with your academic institution and under the Indian Health Care Improvement Act (IHCIA)? (You will receive highest priority placement consideration for available vacancies within the IHS).

6. Are you a former competitive service employee who was separated by a Reduction in Force (RIF) to be considered eligible as a Career Transition Assistance Plan (CTAP) or an Interagency Career Transition Program (ICTAP) applicant or placed on the agencies Reemployment Priority List (RPL) based on a RIF or separated because of work related injuries? (You must submit the appropriate supporting documentation).

Thank you for your interest in this Licensed Practical Nurse position with the Indian Health Service.We will evaluate your resume and your responses to this Assessment Questionnaire to determine if you are among the best qualified for this position. Your responses are subject to verification. Please review your responses for accuracy before you submit this questionnaire.SECTION I. MINIMUM QUALIFICATIONS AND FACTORS.

1. I have a current, valid, active, unrestricted license to practice as a practical or vocational nurse in a State or territory of the United States or the District of Columbia (Must provide a copy of the license, a notarized statement or a citation of the license number and State issuing it).

A. YesB. No

2. I have graduated from an approved School of Nursing within the last 12 months and have applied for a license to practice as a practical or vocational nurse in a State or territory of the United States or the District of Columbia. (NOTE: Appointments may not exceed six months without the employee obtaining licensure/registration. You must furnish the date on which you applied for a license and the jurisdiction involved. No person appointed pending licensure may be retained beyond the probationary period if licensure has not been attained.)

A. YesB. No

Respond Yes or No to the following questions. Your resume and/or supporting documentation must support your responses.

A- YesB- No

3. GS-4 - I have 6 months of nursing experience performing basic or commonly used nursing care work in a hospital, outpatient clinic, nursing home, or other supervised medical, nursing, or patient care facility that provided a practical knowledge of human body structure and sterile techniques and procedures.

4. GS-4 - I have completed a practical nursing program of at least 9 months duration AND I have 1 year of nursing assistant experience (Must provide copy of program completion).

5. GS-4 - I have successfully completed a 2-year degree program in an accredited community college, junior college, or college or university in practical nursing (Must provide copy of transcripts).

6. GS-5 - I have 1 year of nursing experience performing basic nursing care work in a hospital, outpatient clinic, nursing home, or other supervised medical, nursing, or patient care facility.

For each statement below, select the appropriate response that best reflects your experience. Please select only one response. Your resume and/or supporting documentation must support your response.

A- YesB- No

7. I have knowledge of practical nursing theory and practices.

8. I have applied the principles of growth and development, maturation and socialization in providing care appropriate to the age of patients served.

9. I have knowledge of the human body structure, function, illnesses and/or disease entities to communicate with nurses, patients, family members and clinic staff.

10. I have taught patients measures aimed at disease prevention and health promotion such as obesity control, anti-smoking and safety habits.

11. I have recorded and documented patient assessments, such as height, weight, temperature, and blood pressure.

12. I have observed and reliably reported the physical and emotional changes of a patient.

13. I have accurately collected, labeled and recorded specimens obtained.

14. I have prepared and administered dosages.

15. I have observed and recognized the contraindications of prescribed medications in patients.

16. I have administered injections.

17. I have administered childhood vaccinations.

SECTION II. CERTIFICATION OF INFORMATION ACCURACY

As previously explained, your responses in this Assessment Questionnaire are subject to evaluation and verification. Later steps in the selection process are specifically designed to verify your responses. Deliberate attempts to falsify information will be grounds for disqualifying you or for dismissing you from employment following acceptance. Please take this opportunity to review your responses to ensure their accuracy.

Certification of Information Accuracy If you fail to answer this question, you will be disqualified from consideration for this position.

18. I certify that, to the best of my knowledge and belief, all of the information included in this questionnaire is true, correct, and provided in good faith. I understand that if I make an intentional false statement, or commit deception or fraud in this application and its supporting materials, or in any document or interview associated with the examination process, I may be fined or imprisoned (18 U.S.C. 1001); my eligibilities may be cancelled, I may be denied an appointment, or I may be removed and debarred from Federal service (5 C.F.R. part 731). I understand that any information I give may be investigated. I understand that responding "No" to this item will result in my not being considered for this position.

A. Yes, I certify that the information provided in this questionnaire is true, correct and provided in good faith, and I understand the information provided above.B. No, I do not certify/understand the information provided above.